Ulcerative Colitis In Children Research Articles

Gut microbiota predicts the diagnosis of ulcerative colitis in Saudi children.

Ulcerative colitis (UC) is an immune-mediated chronic inflammatory condition with a worldwide distribution. Although the etiology of this disease is still unknown, the understanding of the role of the microbiota is becoming increasingly strong. To investigate the predictive power of the gut microbiota for the diagnosis of UC in a cohort of newly diagnosed treatment-naïve Saudi children with UC. The study population included 20 children with a confirmed diagnosis of UC and 20 healthy controls. Microbial DNA was extracted and sequenced, and shotgun metagenomic analysis was performed for bacteria and bacteriophages. Biostatistics and bioinformatics demonstrated significant dysbiosis in the form of reduced alpha diversity, beta diversity, and significant difference of abundance of taxa between children with UC and control groups. The receiver operating characteristic curve, a probability curve, was used to determine the difference between the UC and control groups. The area under the curve (AUC) represents the degree of separability between the UC group and the control group. The AUC was calculated for all identified bacterial species and for bacterial species identified by the random forest classification algorithm as important potential biomarkers of UC. A similar method of AUC calculation for all bacteriophages and important species was used. The median age and range were 14 (0.5-21) and 12.9 (6.8-16.3) years for children with UC and controls, respectively, and 40% and 35% were male for children with UC and controls, respectively. The AUC for all identified bacterial species was 89.5%. However, when using the bacterial species identified as important by random forest classification algorithm analysis, the accuracy increased to 97.6%. Similarly, the AUC for all the identified bacteriophages was 87.4%, but this value increased to 94.5% when the important bacteriophage biomarkers were used. The very high to excellent AUCs of fecal bacterial and viral species suggest the potential use of noninvasive microbiota-based tests for the diagnosis of unusual cases of UC in children. In addition, the identification of important bacteria and bacteriophages whose abundance is reduced in children with UC suggests the potential of preventive and adjuvant microbial therapy for UC.

The role of endoscopic ultrasonography for assessing the activity of ulcerative colitis in children

Background. Endoscopic diagnostic methods, namely ileocolonoscopy with biopsy, are the „gold standard“ in the diagnosis of ulcerative colitis. Due to the improvement of methods for the diagnosis of ulcerative colitis, the use of endoscopic ultrasonography, that combines endoscopic and ultrasound diagnostic methods, has attracted widespread attention. Endoscopic ultrasonography allows examination of the mucous membrane and the underlying layers of the intestinal wall, which makes it possible to measure the thickness of the intestinal wall. Both in Russia and abroad, there are no publications on the use of endoscopic ultrasonography for ulcerative colitis in children, and that requires further research in this area.
 Aim. To evaluate the possibilities of endoscopic ultrasonography in order to determine the activity of ulcerative colitis in children.
 Materials and methods. The study includes 97 children with an established diagnosis of ulcerative colitis. All children underwent ileocolonoscopy and endoscopic ultrasonography. The UCEIS scale (Ulcerative Colitis Endoscopic Index of Severity) was used to assess endoscopic activity. During endoscopic ultrasonography, the thickness of the intestinal wall and blood flow were evaluated using the color Doppler mapping mode.
 Results. According to the study, there was a statistically significant increase in the thickness of the intestinal wall amid the development of endoscopic activity. The statistically significant increase in the activity of blood flow in the intestinal wall was found.
 Conclusion. Endoscopic ultrasonography is a relatively new research method with a number of functions that can be used to solve complex diagnostic problems in children with ulcerative colitis. The ability to measure the thickness of the intestinal wall and assess the severity of blood flow allows endoscopic ultrasonography to assess patients with ulcerative colitis dynamically, which makes it a promising method in primary diagnosis.

P972 Short and long-term outcomes after acute severe ulcerative colitis in children: A Canadian single centre experience

Abstract Background The short and long-term course of ulcerative colitis (UC) following an episode of acute severe UC (ASUC) in children is insufficiently characterized. We aimed to assess contemporary outcomes in children hospitalized with ASUC. Methods This was a retrospective cohort study of children aged 2-17 years hospitalized with ASUC between 2010 and 2022 at a tertiary center in London, Ontario, Canada. All data were recorded using standardised Case Report Forms, de-identified, and entered into a central database registry using Research Electronic Data Capture (REDCap) Steroid non-response was defined as requirement of medical rescue therapy or colectomy. Results A total of 58 children hospitalized with ASUC were included (male: 55.2% [n =32], mean age at admission: 12.2 ± 3.5 years). The majority had extensive colitis (82.4% [n = 42]) at the time of diagnosis. 74% (n = 43) presented within one year of symptom onset and 31% (n = 18) had ASUC as their index presentation with UC. 15.5% (n = 9) of patients had prior purine analogues and 20.7% (n = 12) had received biologics prior to ASUC presentation. Median Pediatric Ulcerative Colitis Activity Index (PUCAI) score on admission was 65.0 (IQR: 60.0 – 75.0). After intravenous corticosteroid therapy 68.9% (n = 40) responded to steroids. Of the patients with steroid non-response (31% [n = 18]), 3.4% (2/58) underwent colectomy and 27.6% (16/58) patients received infliximab rescue therapy. Median PUCAI score was significantly lower on day 3 between steroid responders and steroid non-responders (37.5 vs 60, p <0.01). The short term (3 months following discharge) and long-term (3-12 months following discharge) colectomy rates following discharge were 7.4% (4/54) and 8% (4/50) respectively. Short term and long-term hospitalization rates for UC exacerbation following discharge was 25.9% (14/54) and 16% (8/50) respectively. Similar rates of long-term colectomy and hospitalizations were observed between steroid responders and non-responders. On univariate analysis, no statistically significant factors associated with steroid non-response were identified. Conclusion 17% of patients hospitalized for ASUC required colectomy within 12 months of presentation. Despite a high initial response to corticosteroids, long term colectomy rates and re-hospitalization rates are still high. Future research should focus on earlier identification and treatment of children at high risk of exacerbation to prevent complications.

A systematic review and meta-regression on international trends in the incidence of ulcerative colitis in children and adolescents associated with socioeconomic and geographic factors

The incidence of ulcerative colitis (UC) among children and adolescents is rising globally, albeit with notable discrepancies across countries. This systematic review and meta-analysis aims to provide a comprehensive overview of the incidence rates of pediatric UC in various countries and explore potential influencing factors. A systematic literature search was conducted in PubMed and EMBASE (via OVID) for studies published between January 1, 1970, and December 31, 2019. Additionally, a manual search was performed to identify relevant systematic reviews. Meta-analyses and meta-regressions were employed to determine the overall incidence rate and examine potential factors that may influence it. A total of 66 studies were included in the qualitative analysis, while 65 studies were included in the meta-analysis and 50 studies were meta-regression. The study reports a rising incidence of pediatric UC in several countries but significant differences across geographic regions, with no discernible global temporal trend. In addition, our meta-regression analysis showed that geographic location and socioeconomic factors significantly influenced the incidence of UC.Conclusion: Our findings indicate a rising incidence of pediatric UC in numerous countries since 1970, but with significant geographical variation, potentially presenting challenges for respective healthcare systems. We have identified geographic and socioeconomic factors that contribute to the observed heterogeneity in incidence rates. These findings provide a foundation for future research and health policies, aiming to tackle the growing burden of UC among children and adolescents.What is Known:• The incidence of ulcerative colitis in childhood and adolescence appears to be increasing worldwide and varies internationally.• Environmental and lifestyle factors are suspected as potential causes.What is New:• Our results highlight that the heterogeneity in incidence rates can be attributed to geographic and socio-economic factors.

Pediatric inflammatory bowel diseases, features of the disease course: a clinical case of complicated course of ulcerative colitis

The article is devoted to one of the urgent problems of pediatric gastroenterology – inflammatory bowel diseases (IBD), which currently include ulcerative colitis (UC) and Crohn’s disease (CD). The prevalence of IBD is inferior to other gastroenterological diseases, but according to the severity of the course, the frequency of complications and the level of mortality, IBD occupy one of the leading places in the structure of diseases of the gastrointestinal tract. The problem of IBD constantly attracts the attention of doctors of various specialties – pediatricians, gastroenterologists, surgeons and others. This is due to an increase in the incidence of this pathology, a variety of clinical manifestations, including extra-intestinal manifestations, faced by doctors of various specialties. In childhood, there is more often a greater prevalence of the lesion, a less specific and erased picture, there is an impact on the physical development of the child. The article provides information on the prevalence, significant factors in the development of the disease; research data revealing the relationship between taking med ications and the risk of IBD onset. The problems of the pathogenesis of the disease, the significance of the genetic status in the development of CD and UC are described. The article presents data on the features of the clinical picture of UC in childhood, recommendations for the primary diagnosis of IBD, including modern laboratory and instrumental research methods. The article also describes the recommended international criteria for assessing the severity of IBD and the problems of differential diagnosis. As a demonstration, the authors’ own observations are presented. The clinical example describes an atypical case of UC in a teenager, occurring with the involvement of the cardiovascular, bronchopulmonary and urinary systems with the development of polyserositis. Early diagnosis of IBD is necessary to prevent disability of patients, ensure further development of the child, improve the quality of life.

P836 Trends in the prevalence of Inflammatory Bowel Disease in Lithuania during 2001-2020

Abstract Background The prevalence of inflammatory bowel disease (IBD) is increasing worldwide, affecting millions of individuals. The highest incidence and prevalence are found in Northern Europe and Northern America. There is a lack of new epidemiological studies in the Eastern European region. The objective of this study was to assess changes in the prevalence of IBD in Lithuania during two last decades. Methods Data on the prevalence of Crohn's disease (CD) and ulcerative colitis (UC) (ICD-10 code K50, K51) in Lithuania during 2001-2020 were obtained from the Institute of Hygiene, where the data were systematized from the Mandatory Health Insurance Information System. Changes in the prevalence trends in men and women, children and adults during 2001-2020 were assessed using Joinpoint regression analysis. Results In 2020, the overall prevalence of CD was 33/100,000 and the prevalence of UC was 117/100,000. Gender differences in the prevalence of IBD were not significant. The prevalence of CD among adults in Lithuania has increased 3-fold over 20 years, while the prevalence of UC has increased 4-fold. During 2001-2020, the average annual increase in UC prevalence (8.0%/year, p<0.001) was higher than in CD (6.3%/year, p<0.001). Also, it shows increased UC/CD ratio: in 2001, the ratio was 2.5:1, while in 2020, was observed a higher UC/CD ratio 3.5:1. When comparing changes in the prevalence of IBD, some differences were observed between adults and children. During 2001-2020, the average annual growth rate of CD in children increased not significantly (2.1%/year, p>0.05), while for adults, a significant increase was observed (6.8%/year, p<0,001). Similar trends were noticed in the assessment of the prevalence changes of UC: during 2001-2020, the prevalence of UC in children increased slightly (3.1%/year, p>0.05), while significant growth was observed for adults (7.8%/year, p<0.001). When comparing the children prevalence ratio of CD and UC, it remained almost the same over 20 years, and it was found that CD is more commonly diagnosed in children than UC (CD/UC ratio in 2001 was 1.8:1, while in 2020, it was 1.7:1). In adults, CD/UC ratio was opposite of children, and has changed during 2001-2020: CD/UC ratio in 2001 was 1:2.9, while in 2020, it was 1:3.7. Conclusion The results show that the prevalence of IBD in adults is steadily increasing, while the number of cases in children has not changed significantly over 20 years. Also, it was observed, that Crohn's disease is diagnosed at younger age than ulcerative colitis, which is more commonly diagnosed in older age.

In silico identification of natural compounds from virgin coconut oil as potential ligand peroxisome proliferator-activated receptor-gamma as preventive food leads against colitis: Is it really work?

Ulcerative colitis (UC) is an inflammation of the large intestine characterized by diarrhea with blood. UC has a more extensive manifestation in children. Current therapy has not given satisfactory results. This is the basis for the need for preventive therapy to reduce the morbidity and mortality of UC in children. Virgin coconut oil (VCO) is a viable dietary supplement option due to its ability to act as a peroxisome proliferator-activated receptor (PPAR) ligand, inhibiting the release of pro-inflammatory cytokines. The aim of this study was to determine natural compounds from VCO that have the potential to prevent colitis using a docking-based virtual screening approach. Quantitative structure-activity relationship analysis was used to find out how similar the input compounds and the database were. Docking is done using AutoDockTools 1.5.6. The algorithm used is the Lamarckian Genetic Algorithm (4.2). PPAR-gamma (PPAR-γ) was used as the target protein in a complex with rosiglitazone (ID PDB: 7AWC). PyMol 2.5.1 was used to prepare and visualize three-dimensional data, and the amino acid interactions were visualized using Discovery Studio 2021 Clients. It was found that linoleic acid and oleic acid in VCO have anti-inflammatory effects with predictive values of 0.73 and 0.614, respectively, and that they stop tumor necrosis factor (TNF) expression with predictive values of 0.751 and 0.724. The result of molecular docking showed that the VCO compound was able to interact with the same residue as the control. VCO reduces inflammation by acting as a PPAR-γ and TNF expression inhibitor.

Efficacy and Safety of Sulfasalazine Suspension in Children With Ulcerative Colitis.

Sulfasalazine (SZ) is commonly used to treat pediatric ulcerative colitis (UC). SZ can be compounded into a suspension form which is beneficial for children with difficulty swallowing a pill. Despite being utilized for over 40 years, there is a lack of published data on the efficacy and safety of SZ suspension in children with UC. Recently, third-party payors have begun refusing to pay for SZ suspension due to lack of data. In this retrospective study, we reviewed the electronic medical records of patients ages <18 years diagnosed with UC from June 1999 to December 2019 at Boston Children's Hospital and treated with SZ suspension as a first-line agent. We obtained demographics, clinical, and endoscopic data to measure outcomes at 1 year and long term. Of 57 patients treated with SZ suspension, 52 (91%) had a follow-up and 26 of 52 (50%) remained in steroid-free remission at 1 year. Two patients were switched to SZ tablets due to nonmedical reasons and 11 (21%) required rescue treatment (2 infliximab, 1 tacrolimus, 8 6-mercaptopurine/azathioprine) within a year. Three required colectomy within a year and 5 in long term. Four (8%) developed nonserious adverse reactions and switched to 5-aminosalicylates (5-ASA) by 1 year. The median duration of long-term follow-up was 36 months (range, 2-205 months) with 28 requiring treatment escalation in long term. SZ suspension is a safe and effective treatment for UC in children with difficulty swallowing a pill. The 1-year remission rate on this treatment is comparable to 5-ASA utilized in children.

A critical review of adalimumab for the treatment of moderate-to-severe active ulcerative colitis in children

Introduction Anti-TNF antibodies play a major role in treating IBD, both in adult and paediatric patients. While there is a large number of studies on efficacy and safety of infliximab in treating children and adolescents with UC, data on adalimumab (ADA) are scarce. Areas covered Here, we review published case reports, cohort and real time data as well as the first randomized trial, ENVISION I, using ADA for treating paediatric UC. Available evidence confirms good efficacy inducing and maintaining remission in children and adolescents with UC, with even higher response rates compared to adult UC. ENVISION I showed that in UC patients responding to ADA induction therapy almost half of the patients remained in remission after 52 weeks of therapy on high-dosing ADA (weekly administration). As already well experienced with other biologics, dosing schemes are different between paediatric and adult patients, with children often requiring higher dosing. Expert opinion: Further data are required to better understand how to optimize ADA therapy. The present and still growing evidence places sc. anti-TNF-medication as alternative first line therapy also for paediatric UC. This is also reflected by the preference for sc. medication of adolescent patients allowing less frequent and autonomous drug administration.

Transanal ileal pouch anal anastomosis for ulcerative colitis in children and adults: a systematic review and meta-analysis.

The incidence of pediatric onset ulcerative colitis (UC) is increasing, with increasing rate of children eventually requiring surgical treatment. Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment. Although transanal IPAA (ta-IPAA) is becoming widely accepted for adult UC patients, data regarding this procedure in children are scarce. Nevertheless, some adult publications also include patients under 18years old. This systematic review and meta-analysis aimed to summarize surgical and functional outcomes following ta-IPAA, and extract conclusion regarding pediatric UC patients. PubMed, Cochrane Library databases, Embase, Web of science and Google Scholar databases were searched, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guidelines. The final search was updated in April 2022. Four comparative cohorts (n = 868) and 11 non-comparative case series (n = 241) were included. Six reports included children. Anastomotic leak, complications, operative time, conversion rate, length of stay and functional outcomes were examined. A total of 1103 patients, ranging 9-79years were included in this review. We found no difference in risk for anastomotic leak (OR 1.36, 95% CI 0.46-4.06), minor and major complications (OR 0.92, 95% CI 0.48-1.76 and OR 0.78 95% CI 0.36-1.69, respectively) comparing ta-IPAA to transabdominal IPAA. Short- and long-term follow-up showed satisfying functional outcomes and quality of life. Our review suggests that ta-IPAA is not inferior to transabdominal IPAA. Implementation of this method in children is technically feasible due to familiarity with the dissection plane. Long-term functional outcomes and quality of life are paramount in the pediatric population and should be particularly investigated. Multicenter prospective studies are required to investigate pediatric UC patients undergoing ta-IPAA.

Methylation of RUNX3 Promoter 2 in the Whole Blood of Children with Ulcerative Colitis.

Ulcerative colitis (UC) results from a complex interplay between the environment, gut microbiota, host genetics, and immunity. Runt-related transcription factor 3 (RUNX3) regulates Th1/Th2 balance and, thus, the synthesis of cytokines and inflammation. We aimed to analyze the dependence of RUNX3 promoter 2 (P2) methylation level on: age, sex, body mass index (BMI), C-reactive protein (CRP), serum albumin, disease duration, Pediatric Ulcerative Colitis Activity Index (PUCAI), the Paris classification, and exposure to medications. This multicenter, cross-sectional study recruited hospitalized children with UC. Methylation of RUNX3 P2 was measured with methylation-sensitive restriction enzymes in the whole blood DNA. Sixty-four children were enrolled, with a mean age of 14.5 ± 2.8 years. Half of them were female (51.6%), and the average BMI Z-score was −0.44 ± 1.14. The mean methylation of RUNX3 P2 was 54.1 ± 13.3%. The methylation level of RUNX3 P2 did not correlate with age, sex, nutritional status, CRP, albumin, PUCAI, or the extent of colitis (Paris E1–E4). RUNX3 P2 methylation did not differ between patients recruited within two and a half months of diagnosis and children who had UC for at least a year. Current or past exposure to biologics, immunosuppressants, or steroids was not associated with RUNX3 P2 methylation. Methylation of RUNX3 promoter 2 in whole blood DNA does not seem to be associated with the characteristics of UC in children.

Analysis of the Clinical Efficacy of Infliximab in the Treatment of Steroid-Refractory Ulcerative Colitis in Children

Background: Incidence of ulcerative colitis (UC) in children has increased worldwide. Objectives: In the current study, we summarized our clinical experience using infliximab (IFX) in the treatment of children with steroid-refractory UC. Methods: The clinical data of 9 steroid-refractory UC patients with average age of 8 years who were treated with IFX in our hospital were analyzed. Results: At the end of the induction period, 6 achieved a clinically significant response. Of the 6 children, 4 had mucosal healing and 2 had endoscopic remission. At week 30, among the 6 children who achieved a clinically significant response, 3 had persistent clinical remission and mucosal healing, 1 achieved mucosal healing from endoscopic remission, 1 had mild disease, and the other child had not reached 30 weeks of treatment as of this writing. At week 54, 6 of 9 children achieved clinical remission and 5 had mucosal healing. The hemoglobin concentration in the children who achieved a clinically significant response was higher than pre-treatment and the inflammation markers were lower than pre-treatment. During IFX treatment, five children had a loss of response, three had a primary non-response, and two had a secondary non-response. The latter children achieved clinical remission with optimized treatment. Conclusions: IFX is a salvage treatment option for children with moderate-to-severe steroid-refractory UC. The course of treatment and the timing of drug withdrawal warrants further study.

Psychological interventions for inflammatory bowel disease: a systematic review and component network meta-analysis protocol

IntroductionPatients with inflammatory bowel diseases (IBD) often report psychological problems, unemployment, disability, sick leave and compromised quality of life. The effect of psychological interventions on health-related outcomes in IBD is...

Draft clinical guidelines for endoscopic diagnosis of ulcerative colitis in children

The article summarizes clinical guidelines for endoscopic examinations (esophagogastroduodenoscopy, ileocolonoscopy, video capsule endoscopy) in children with ulcerative colitis (UC). Such issues of endoscopic examinations and monitoring of UC as indications for primary and repeated examinations, technical aspects of examinations, biopsy, endoscopic activity indices and endoscopic semiotics of UC, the role of video capsule endoscopy are considered.

Regional features of the course of ulcerative colitis: clinical observations (on the example of Rostov-on-Don)

The aim of the study was to identify the clinical, epidemiological and therapeutic features of ulcerative colitis in children in Rostov-on-Don. Under the observation were 34 children aged 1 to 14 years with a diagnosis of ulcerative colitis, which was based on anamnesis, clinical picture, laboratory results, and colonoscopy. The activity of ulcerative colitis was assessed taking into account the PUCAI index. To determine the reliability of the compared indicators (%), the χ2 criterion was used. Clinical and epidemiological studies have shown an increase in the incidence of ulcerative colitis in children in Rostov-on-Don over the past 10 years. In the clinic of ulcerative colitis, mild, erased forms of the course of the disease dominated, which determined the later diagnosis at the prehospital stage. There was a «rejuvenation» of the disease: ulcerative colitis was more often detected in the preschool group of children. The incidence of ulcerative colitis in boys was higher than in girls. In the treatment of mild and moderate forms of ulcerative colitis, the use of basic drugs is very effective, taking into account the principle of «step up».

P072 Non-invasive Vagal Nerve Stimulation to Treat Crohn Disease and Ulcerative Colitis in Children and Young Adults: A Proof-of-Concept Clinical Trial.

Current inflammatory bowel disease (IBD) therapies are limited by incomplete efficacy, loss of response, side effects and high costs. Vagal nerve stimulation (VNS) is an investigational Bioelectronic Medicine therapy targeting the nervous system to treat IBD through an 'inflammatory reflex' that reduces systemic inflammation. Data in humans with IBD are promising but limited to two small studies using a cervically implanted VNS device in adults with Crohn disease (CD); no data exist to date using a non-invasive VNS modality in IBD. This study aimed to evaluate the efficacy and safety of transcutaneous auricular VNS (ta-VNS) in children and young adults with CD or ulcerative colitis (UC). IBD patients 10-21 years of age with mild/moderate CD or UC who did not achieve remission with conventional therapy, and a fecal calprotectin (FC) >200 ug/g within 4 weeks of study entry were enrolled. Subjects were randomized to receive either ta-VNS using a transcutaneous electrical nerve stimulator unit targeting the cymba conchae of the external left ear, or sham stimulation of the posterior lower leg, for 5 minutes once daily for a 2-week duration followed by a switch to the alternative stimulation for an additional 2 weeks. At week 4, all subjects were assigned to receive active ta-VNS for 5 minutes twice daily until week 16 so that all received 14 weeks of active ta-VNS by the end of the study. Primary study endpoint was defined as ∆FC ≥50% reduction from baseline to week 16. Secondary endpoints included improvement in weighted Pediatric Crohn Disease Activity Index (wPCDAI) or Pediatric Ulcerative Colitis Activity Index (PUCAI). Twenty-two subjects were enrolled (12 UC, 10 CD; median age 14.4 years [range 10-21] 54.5% male). Median baseline FC was 587 (range 18 - 3828, SD 1074). 5 subjects (4 UC, 1 CD) had FC levels 12.5 at baseline, 3 (50%) achieved clinical remission (wPCDAI ≤ 10) at week 16. In the full UC cohort (n = 12), baseline PUCAI ranged from 0-45. In the 6 with PUCAI > 10 at baseline, 2 (33%) achieved clinical remission at week 16. There were no safety concerns. Non-invasive ta-VNS reduced FC levels and improved symptoms in a pediatric cohort with mild/moderate IBD. Further research is needed to identify optimal electrical dose and settings to achieve peak anti-inflammatory effect and to identify the mechanistic principles for this therapy.

Nutritional Impact of Medical Management and Operation in Responsive and Refractory Ulcerative Colitis in Children

Nutritional Impact of Medical Management and Operation in Responsive and Refractory Ulcerative Colitis in Children

Laparoscopic robotic-assisted restorative proctocolectomy and ileal J-pouch-anorectal anastomosis in children.

Total proctocolectomy with ileal J-pouch-anorectal anastomosis (IPAA) remains the preferred surgical treatment for ulcerative colitis (UC) in children. Considering the well-known advantages of minimally invasive approach, and its main application for the deep pelvis, robotic surgery may be used in UC reconstructive procedures. The aim of the study is to report our experience with Robotic IPAA in children. Single surgeon experience on Robotic IPAA were prospectively included. Data on patient demographics, surgical details, complications, and length of stay (LOS), were collected. Fifteen patients were included. Median age was 13.2years, median body weight 45kg. Median operative time was 240min. Median LOS was 7days and mean follow-up time 1year. No intraoperative complication occurred. Five postoperative complications happened: 3 minors treated conservatively (CD I-II), 2 majors needing reintervention under anesthesia (CD IIIb). No mortality was observed. Our preliminary experience reveals that Robotic IPAA is a safe and feasible option for the surgical treatment of UC in children. A bigger patient sample and a long-term follow-up are needed to confirm our findings.

Морфологические особенности клинических форм язвенного колита у детей

Актуальность. Язвенный колит (ЯК) — хроническое воспалительное заболевание неуточненного происхождения, характеризующееся клинически рецидивирующим течением с периодами кровавой диареи и патоморфологически — диффузным воспалительным процессом в толстой кишке. Проблема язвенного колита требует дальнейшего изучения клинических особенностей заболевания с учетом локализации, степени активности воспалительного процесса, изменений структуры слизистой оболочки, что будет способствовать повышению эффективности диагностики ЯК в детском возрасте. Материалы и методы. На основе клинико-статистического анализа 116 историй болезни детей с ЯК в возрасте 4–18 лет в периоде обострения болезни изучены особенности клинических форм ЯК — тотального, сегментарного и дистального. Гистологически было исследовано 445 биоптатов, полученных при колоноскопии. После забора материала биоптаты фиксировали в 10% формалине и обрабатывали по общепринятой гистологической методике с окраской срезов гематоксилин-эозином и по Ван Гизону. Результаты. В механизмах развития обострения ЯК существенное значение имеют изменения архитектоники слизистой оболочки толстой кишки, которые способствуют снижению резистентности слизистого барьера, а также нарушения кровоснабжения — фактор развития гемической гипоксии.

Факторы риска язвенного колита у детей

Актуальность. Воспалительные болезни кишечника на сегодняшний день являются одной из актуальных проблем детской гастроэнтерологии, что обусловлено стремительным распространением данной патологии, смещением дебюта болезни на ранний возраст ребенка (первые три года жизни), формированием тяжелых осложнений, низкой эффективностью современных схем лечения. Проблема язвенного колита у детей требует дальнейшего всестороннего изучения, в том числе факторов риска возникновения заболевания, что позволит формирование групп риска развития болезни, обоснование профилактических мероприятий по ее предупреждению. Материалы и методы. Изучение факторов риска проводилось путем опроса 100 матерей, дети которых болели язвенным колитом. Контрольную группу составили 30 матерей здоровых детей. Результаты. На основании математического анализа медико-биологических факторов риска развития язвенного колита у детей определены наиболее значимые: отягощенная наследственность по заболеваниям органов пищеварения, кишечные дисфункции в раннем возрасте, повторные курсы антибиотикотерапии, вторичная лактазная недостаточность, частые респираторные болезни. Разработан алгоритм прогнозирования язвенного колита в детском возрасте, обоснованы подходы к профилактике данной патологии.